Support Aging In Place Research Articles

Supporting Aging in Place with the Introduction of Artificial Intelligence Technologies

As our growing population ages, there is a stronger push to age in place. Adults want to stay in their homes and communities as long as possible despite degenerative health issues. With adequate education and support, the growing desire for adults to age in their homes can be met with the strategic integration of AI technologies to maximize safety and bolster engagement in meaningful activities. This seemingly simple solution is complicated by the intersection of unique learning styles and the complexities that come with a generation that is cautious of even the simplest technology. Adopting a person-centered framework is vital for the success of AI-supported aging in place. As an occupational therapist, with experience across geriatric populations and a special interest in adaptive technology, I provide unique insight into effectively introducing AI technologies into the daily lives of older adults throughout this experiential report.

Aging in Place

What Is the Issue? Canada is experiencing an important demographic transition toward an increasingly diverse aging population with an increased need for care and support during the later stages of life. Despite older adults’ strong preferences to live in their home or community for as long as possible, health systems are challenged to keep up with growing demands for home care, community care and support services to support conditions to age in place, when appropriate. What Did Canada’s Drug Agency Do? Canada’s Drug Agency prepared an Evidence Assessment report that identified and described the current context of aging and hinderances to aging in place in Canada, considerations relevant to aging in place for equity-deserving groups, strategies and initiatives intended to address unmet needs and improve outcomes, and systemic considerations related to implementing initiatives supporting aging in place. The Health Technology Expert Review Panel (HTERP) used the Canada’s Drug Agency Evidence Assessment report to inform deliberations and to develop objective, impartial, trusted pan-Canadian guidance for decision-makers when considering evidence-informed aging-in-place initiatives to support equitable aging in place in jurisdictions in Canada. What Is HTERP’s Position on Aging in Place? Everyone has the right to age with dignity. Aging is a normal part of life and may be accompanied by changes in health status and/or abilities to complete everyday self-care tasks. Older adults comprise a heterogenous population with a continuum of health care needs and risks, including people living with vitality, those with moderately complex care issues, and those with complex care issues. Health and social systems were originally designed to meet the less complex acute care needs of a younger population and operate largely in silos. They cannot adequately or proactively address the continuum of needs of many older adults and their caregivers. Aging in place is a dynamic and complex experience that occurs within a larger context that is not limited to health systems. Older adults’ autonomy and preferences for care are realized by the active role of informal unpaid caregivers. The population of older adults in Canada is diverse with varying needs, risks, and cultural norms and values related to aging in place. Barriers to aging in place may disproportionately affect members of equity-deserving groups that experience multiple and often intersecting historical, social, cultural, medical, structural, institutional, and environmental barriers to care and support. There must be equity in access to safe, appropriate, and ongoing care to support dignity in living in a place of one’s choosing for older adults as they age. What Is HTERP’s Guidance to Support Aging in Place? foster a system that prioritizes integrated models of care to address current and future unmet needs and bridge gaps in and between services identify interventions that are aligned within an integrated model of care and are responsive to the unique and complex needs of older adults and their unpaid caregivers ensure culturally appropriate and equitable opportunities for positive outcomes standardize core measures or indicators to guide data collection, analysis, use, and reporting that support robust evaluation and cross-jurisdictional comparisons of interventions.

Medical Foster Home: A Model to Support Aging in Place and Develop Community for Older Adults

Medical Foster Home: A Model to Support Aging in Place and Develop Community for Older Adults

Leveraging Technology to Support Aging in Place: Opportunities, Challenges and Recommendations.

The aging population presents pressing societal challenges, emphasizing the importance of aging in the right place to support older individuals' quality of life. Technology can play a crucial role in facilitating aging in place by enabling multiple factors such as remote healthcare monitoring, social connectivity and access to essential services. However, several challenges must be addressed to ensure widespread adoption and effective usage of technology among older adults. From integrating digital literacy into the United Nations' Sustainable Development Goals (United Nations n.d.) to promoting co-creation and fostering intergenerational dialogue, multiple solutions can be envisioned. This commentary emphasizes these opportunities, discusses these issues and provides a set of recommendations.

"I Want to Do Something" - Exploring What Makes Activities Meaningful for Community-Dwelling People Living With Dementia: A Focused Ethnographic Study.

Supporting ageing in place, quality of life, and activity engagement are public health priorities for people with dementia. The importance of maintaining opportunities for meaningful activities has been widely acknowledged for those with dementia in long-term care, but little is known about what makes activities meaningful for, and how they are experienced by, people with different types of dementia in their own homes. This study used focussed ethnographic methods to explore the motivations and meanings of everyday activity engagement within the homes of 10 people with memory-led Alzheimer's disease and 10 people with posterior cortical atrophy. While participants' interactions with their everyday environments were challenged by their diagnoses, they were all finding ways to continue meaning-making via various activities. The main findings are encapsulated in three themes: (1) The fun and the function of activities; (2) Reciprocities of care, and (3) The constitution and continuity of (a changing) self. Ongoing engagement with both fun and functional activities offered participants living with different dementias opportunities to connect with others, to offer care and support (as well as receive it), and to maintain a sense of self and identity. Implications are discussed regarding the development and delivery of tailored interventions and support to enable continued engagement in meaningful activities for people with different types of dementia living in the community.

Nurse-Led Models of Care: Practice and Policy to Support Aging in Place.

Research demonstrates that aging in place is the goal of most adults aged >50 years. Unfortunately, multiple barriers to aging in place continue to exist, especially for vulnerable populations. Achieving this goal will require innovative nurse-led models of care and new policies for RN reimbursement. The current article describes a nurse-led clinic implemented in one community. Using an evidence-based nurse-led model of care, a team of university faculty, students, and a family nurse practitioner designed and implemented a nurse-led clinic for a religious community in the Pacific Northwest. Today, the nurse-led clinic offers care coordination and primary care to support aging in place and is one example of a nurse-led model well-positioned to address the aging in place needs of vulnerable populations. Replication and sustainability of this nurse-led model requires sweeping policy change, including consideration of requiring all nurses to attain a National Provider Identification number to expand RN reimbursement and ultimately increase access to care. [Journal of Gerontological Nursing, 50(3), 13-17.].

RECOGNIZING THE ROLE OF PETS IN HOME ASSESSMENTS FOR OLDER ADULTS

Abstract To support aging in place, health professionals may identify safety and accessibility concerns via home assessments. Although 50% of older adults share their homes with pets, standardized home assessments often overlook pet care, an instrumental activity of daily living (IADL). To bridge this gap in existing knowledge, we conducted four focus group sessions with older adult pet owners to identify potential elements for a novel assessment tool. We utilized directed content and thematic analysis, informed by the International Classification of Functioning, Disability and Health model. Researchers recruited a purposive sample of older adults (65 years or older) who were the primary caretakers of a dog or cat. Participants (N=30) discussed age-related changes to their body’s function that hindered their participation in pet care activities (e.g., the strength needed to pick up a pet). Participants explained how the interaction of their pets and housing features (e.g., stairs) contributed to falls and injuries. Further, personal factors (e.g., restricted income) may contribute to home safety issues (e.g., unable to afford needed modifications). The results indicate that pets’ behavior, care needs, and caregiving activities may impact home safety, thereby influencing the potential for aging in place. Findings support the development of holistic approaches when evaluating older adults’ functioning in their homes and emphasize the importance of pet care within home assessments.

Factors that Motivate and Support Aging in Place.

Previous research demonstrated a gap in research regarding low-income older adults who age at home. This research study focused on evaluating the motivation of low-income older adults who age in place and gaining an improved understanding of areas of motivation. The sample consisted of seven older adults in North Carolina who are affiliated with a non-profit. Data collection consisted of semi-structured interviews conducted in the participant's home. The research team conducted triangulation, theme development, and pattern development. The research revealed five themes: previous history, environmental factors, desire for safety, daily routines, and personal values. The themes are supported by the theoretical background of self-determination theory, Maslow's hierarchy of needs, and the Model of Human Occupation. It was concluded that previous history, external motivation, faith, and need for adequate housing are solid factors for older adults to age in place.

Socially active neighborhoods: construct operationalization for aging in place, health promotion and psychometric testing.

From the year 2003 when the first walkability scale was published to date, person-environment fit models and empirical research, some of which was published in Health Promotion International, have encapsulated healthy communities in 'neighborhood walkability'. While there is no doubt that neighborhood walkability positively influences health-seeking behaviors and health, recent models suggest that their measurement and conceptualization have not emphasized the role played by psychosocial and personal factors in aging in place. Thus, the development of scales measuring human ecosystem factors has not recognized all critical factors suited for older adults. In this paper, we aim to draw on relevant literature to frame a more holistic construct, hereby referred to as Socially Active Neighborhoods (SAN), that would better support aging in place in older populations. Through a narrative review based on a systematic search of the literature, we define the scope of SAN and delineate some contextual implications for gerontology, health promotion and psychometric testing. SAN, unlike neighborhood walkability in its current measurement and conceptualization, incorporates critical theory-informed psychosocial factors (i.e. safety and disability friendliness of neighborhood infrastructure) that can encourage older adults with physiological and cognitive limitations to maintain physical and social activities as well as health in later life. The SAN is the result of our adaptation of key person-environment models, including the Context Dynamics in Aging (CODA) framework, that recognizes the role of context in healthy aging.

Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults—An Exploratory Home-Based Study of an Underserved Group in Research

Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments. Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research. Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.

"The Sun Came Up Because You Got Here…": A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia.

In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.

Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation.

BackgroundThe province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults.ObjectiveThis study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada.MethodsBetween October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis.ResultsParticipants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest).ConclusionsOur findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers’ awareness of the service and its benefits.

Embedding Physical Activity Within Community Home Support Services for Older Adults in Ireland - A Qualitative Study of Barriers and Enablers.

IntroductionIn Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program.MethodsWe conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery.ResultsBarriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme.ConclusionOur findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place.

Creating Virtual Community For Older Adults: During the COVID-19 Pandemic And Beyond

Combining data on health and well-being from the University of Michigan National Poll on Healthy Aging (NPHA) with case studies and data from GetSetUp, a virtual online learning community, and the Michigan Department of Health and Human Services (MDHHS), this symposium will highlight how virtual community can be created and supported during the COVID-19 pandemic and beyond. Polling data on loneliness and physical environments demonstrate the need for opportunities for connection before and during the pandemic. Other polling data from the NPHA shows telehealth visits increased significantly as did the use of video chat technology. These findings suggest that comfort with technology may help support aging in place. GetSetUp helps to make this possible with customized learning to help older adults overcome hurdles to tech adoption and use. GetSetUp classes focus on supporting social connection and providing information on resources and services. Beyond the pandemic, these services will remain critical for many older adults, including those facing mobility limitations, those with limited community, and those looking to diversify their networks. The Senior Deputy Director of Aging and Adult Services Agency will highlight how Michigan combines data and technology to support Michigan’s aging network. The GetSetUp and MDHHS virtual community allowed for a statewide connection to health and aging services, including programs such as vaccine information sessions. The data and case studies described will highlight the need for connection during the COVID-19 pandemic and how a startup and State worked together to address this need.

A Mixed-Methods Analysis of Care Arrangements of Older People with Limited Physical Abilities Living Alone in Italy.

Older people with limited physical abilities, who live alone without cohabiting family members, need support ageing in place and to perform daily living activities. In this respect, both the available informal and formal care seem crucial. The present study aimed to explore the current role of the care arrangements of older people, especially if they have functional limitations. Qualitative interviews were carried out in 2019 within the “Inclusive ageing in place” (IN-AGE) research project, involving 120 older people who lived at home, alone, or with a private personal care assistant (PCA) in three Italian regions (Lombardy, Marche, and Calabria). A mixed-methods analysis was conducted. Results showed that support networks are still mainly made up of family members, but also of domestic home help (DHH) and PCAs, friends/neighbours, and public services, albeit the latter provide support in a residual way, while the former is not as intensive as it was in the past. Frequency and geographical/living proximity of help play a role, emerging also as a territorial differentiation. The paucity or absence of support, especially from the family, risks compromising the ability of ageing in place. It seems, thus, necessary to innovate and improve, in particular, home services, also through real formal and informal care integration.

199 EMBEDDING PHYSICAL ACTIVITY WITHIN HOME CARE SERVICES FOR OLDER ADULTS IN IRELAND—A QUALITATIVE STUDY OF BARRIERS AND FACILITATORS

Abstract Background In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme. Methods We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme. Conclusion Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.

Technology Domestication in Later Life

ABSTRACT Technology domestication in old age may promote autonomy and support aging in place, but most previous research did not follow the process of domestication over time and in real life conditions. To gain deeper understanding of technology domestication in later life, we simultaneously explored uses, outcomes and constraints in real life conditions in a longitudinal study. Nineteen community-dwelling women aged 75–90 were provided with voice-controlled Intelligent Personal Assistants (Google Home) and their experiences with them were documented for three months via semi-structured interviews, observations, and weekly surveys. Analysis identified three different patterns of technology domestication: “Broad domestication” characterized by a high level of integration and ongoing experimentation, “focused domestication” in which the user mainly adopted one of the device’s functions, and “restrained domestication” wherein a short period of experimentation was followed by occasional use, if any. Demonstrating that the process of technology domestication is not homogeneous, the findings call for some theoretical updates and offer several practical implications.

End-of-Life Care in Community-Based Services at Nursing Multifunctional Small Group Homes: Supporting Aging in Place

End-of-Life Care in Community-Based Services at Nursing Multifunctional Small Group Homes: Supporting Aging in Place

Voice Technologies to Support Aging in Place: Opportunities and Challenges

Technology to support aging in place has been a topic of interest. Research indicates that older adults are increasingly using commercially available voice assistants in smart speakers. These devices enable non-visual interaction that does not require extensive expertise with traditional mobile or desktop computers, thus offering new possibilities of access to digital technology. We conducted two different studies with individuals aged 65 years old or above—a three week smart speaker deployment study with individuals who did not use computing devices regularly and a workshop on customizing internet of things technology with tech savvy individuals. Our findings indicate specific ways that these voice technologies might support aging in place, including ease of use and due to their not being identified with aging-specific technologies. We observed that participants consistently used their voice agent for finding online information, particularly health-related, emphasizing the need to revisit concerns about credibility of information with this new interaction medium. And, although features to support memory (e.g., setting timers, reminders) were initially perceived as useful, the actual usage was unexpectedly low due to reliability concerns. Our work provides a basis to understand older adults’ perceptions and usage of current voice technologies. We also identify opportunities for customizing voice technologies to better support aging in place.

Leveraging Assistive Technology Resources to Support Aging in Place: A Scoping Study

Aging in place is the preferred living arrangement for most older adults. However, the challenges that often accompany longevity coupled with housing which lacks proper modifications presents concerns about older adults’ safety and wellbeing. Advancements in assistive technologies have promising potential in helping address many of these challenges and support aging in place. The purpose of this scoping review was to survey the current literature to understand why, how, and what assistive technologies are adopted and utilized to help support aging in place. We followed the Arksey and O’Malley (2005) methodological framework for scoping studies, searching seven databases and systematically assessed 611 titles/articles. Findings were organized using frequencies and themes. Following the inclusion/exclusion criteria, 12 articles were included. Upon thematic analysis, three main themes emerged: 1.) challenges experienced in the context of aging in place, 2.) technology adoption, and 3.) technology types and applications. Findings indicate technology can serve an important role in helping support aging in place and can serve as a medium to deliver and increase access to resources to support physical, social, and psychological wellbeing. The technologies most frequently utilized include personal devices and smart home technologies. The adoption and use of technologies can be impacted by the perceived ease of use, perceived usability, family/caregiver, self-selection, involvement in technology development, policies supporting access, and environment factors. Our findings indicate that there is a current gap in the understanding of how older adults are interacting with technology and how long term use impacts wellbeing and aging in place.